Provider Demographics
NPI:1740367903
Name:LIYANAGE, DINESHI LASITHA (MD)
Entity type:Individual
Prefix:DR
First Name:DINESHI
Middle Name:LASITHA
Last Name:LIYANAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25042
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5042
Mailing Address - Country:US
Mailing Address - Phone:559-438-1245
Mailing Address - Fax:559-892-4550
Practice Address - Street 1:550 E HERNDON AVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2992
Practice Address - Country:US
Practice Address - Phone:559-438-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76771207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN369Medicare PIN
I01511Medicare UPIN